Table 1.
Department of Health and Human Services Payment Taxonomy Framework
| Characteristic | Category 1: FFS Without Links to Quality |
Category 2: FFS With Links to Quality |
Category 3: APMs Built on FFS Architecture |
Category 4: Population and Personal Payments |
|---|---|---|---|---|
| Description | Service-based reimbursement | A portion of reimbursement tied to quality and efficiency outcomes | Payments remain tied to individual service volume; increased accountability for quality and efficiency; incentives for population health management | Reimbursement based on attributed patient population over a defined period; accountability for cost and quality |
| Examples | FFS | PQRS; value-based payment modifier; hospital readmissions penalty; MIPS | Medicare Shared Savings ACOs (tracks 1, 2a, and 3a)b; BPCI, CCJR bundled payments; AMI EPMa; medical homes; Next Generation ACOa,b; Comprehensive Primary Care Plusa | Pioneer ACO (years 3–5)b |
Abbreviations: ACOs, accountable care organizations; AMI EPM, Acute Myocardial Infarction Episode Payment Model; APMs, alternative payment models; BPCI, Bundled Payments for Care Improvement; CCJR, Comprehensive Care for Joint Replacement; FFS, fee-for-service; MIPS, Merit-Based Incentive Payment System; PQRS, Physician Quality Reporting System.
a
These models qualify for the APM pathway in the Medicare Access and Children’s Health Insurance Program Reauthorization Act proposed rule.
b
Multiple variations of ACOs exist, allowing each to establish a leadership and administrative infrastructure and to include gain sharing only or may have downside risk.